腹腔镜线性单侧髂耻韧带悬吊术治疗中盆腔器官脱垂  

Laparoscopic unilateral pectopexy in the treatment of middle pelvic organ prolapse

作　　者：张庆霞[1] 阳艳军[1] 王扬[1] 梁静[1] 凌斌[1] 陈庆云[1] Zhang Qingxia;Yang Yanjun;Wang Yang;Liang Jing;Ling Bin;Chen Qingyun(Department of Obstetrics and Gynecology, China- Japan Friendship Hospital, Beijing 100029, China)

机构地区：[1]中日友好医院妇产科,北京100029

出　　处：《中华腔镜外科杂志（电子版）》2020年第6期362-366,共5页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的探讨腹腔镜线性单侧髂耻韧带悬吊术治疗中盆腔器官脱垂的可行性、安全性和临床结局。方法选取2015年6月至2017年6月在中日友好医院妇科因POP-Q评分≥Ⅱ度且中盆腔器官脱垂为主行腹腔镜线性单侧髂耻韧带悬吊术20例,比较术前与术后36个月的POP-Q评分、生活质量评分(盆底功能障碍问卷-20、盆底疾病生活质量影响问卷短表-7),统计患者围手术期参数和临床疗效。结果20例患者均成功完成手术,术中均无肠管等脏器损伤,术后随访(49±6)个月,1例发生尿潴留,未发现缝线暴露等并发症。术后36个月复查根据POP-Q分期法测定脱垂均无复发,解剖治愈率100%。POP-Q的Aa、Ba、Ap、Bp、C和TVL各项上,术前与术后36个月差异均有统计学意义(P<0.01);术前及术后36个月生活质量评分PFDI-20[(91.06±25.02)分比(25.17±8.10)分]及PFIQ-7[(98.42±25.36)分比(24.98±9.02)分],差异均有统计学意义(P<0.01),主观满意度为100%。结论腹腔镜线性单侧髂耻韧带悬吊术为治疗中盆腔缺陷提供新的思路和选择,其微创、简单、安全、有效,容易学习和掌握,仍需大型随机对照研究来进一步观察远期疗效及并发症。Objective To study the efficiency and safety of laparoscopic unilateral pectopexy which uses sling suspension in the treatment of middle pelvic organ prolapse.Methods 20 patients who underwent laparoscopic unilateral pectopexy(a sling suspension without mesh)due to middle pelvic prolapse with POP-Q score above II was analyzed in our department from Jun.2015 to Jun.2017.The clinical efficacy were evaluated by comparing the POP-Q score,PFDI-20 and PFIQ-7 questionnaires before operation and 36 months after operation to understand the subjective satisfaction.Results The operations were successfully completed in the 20 patients.No injuries of rectum or other organs occurred.One case of postoperative urine retention was cured one week later.The Aa,Ba,Ap,Bp,C and TVL of POP-Q were significantly different before and 12 months after operation(P<0.01)or before and 36 months after operation(P<0.01).There were significant differences in PFDI-20[(91.06±25.02)vs(25.17±8.10)]and PFIQ-7[(98.42±25.36)vs(24.98±9.02)]scores before operation and 36 months after operation(P<0.01).Subjective satisfaction was 100%.Conclusions Laparoscopic unilateral pectopexy,a sling suspension without mesh,is a new method for the treatment of middle pelvic organ prolapse,which is safe,effective and easier to learn.Large randomized controlled trial are still needed to further observe the long-term efficacy and complications.

关 键 词：盆腔器官脱垂 腹腔镜 髂耻韧带悬吊术 盆腔器官脱垂定量分度法 

分 类 号：R71[医药卫生—妇产科学]